Early schizophrenia often presents with depressive symptoms, anxiety symptoms, and obsessive-compulsive symptoms that can be misdiagnosed as depression, anxiety disorder, and OCD. And some depression, anxiety, and obsessive-compulsive disorders early in life will have some hallucinogenic-like symptoms, delusional-like symptoms, and some seemingly absurd and bizarre ideas will be misdiagnosed as schizophrenia. Some adolescent schizophrenic disorders have exaggerated thoughts and active but slightly incongruent affect early on that can be misdiagnosed as mania, while some manic disorders have some hallucinogenic-like symptoms, delusion-like symptoms, some seemingly absurd and bizarre thoughts, and incongruent affect and behavior early on that can be misdiagnosed as schizophrenia.
The misdiagnosis of these diseases with each other will delay the best treatment time of each disease and cause serious consequences. For example, the best time to treat schizophrenia is in the first six months after the onset of the disease, and the outcome is often poor when this optimal treatment window is missed. Early schizophrenia patients taking antidepressants sometimes worsen psychiatric symptoms and can even lead to suicide. Similarly early depression patients taking antipsychotics can sometimes worsen depressive symptoms and even lead to suicide. Therefore, how to accurately identify early schizophrenia and early symptoms of depression, anxiety, obsessive-compulsive disorder, and mania is a major challenge for psychiatry at present, so early psychosis identification intervention associations have been established in Western countries, and our group has conducted related research earlier in China. The following is just a brief introduction of the clinical points for mutual identification of early symptoms of these disorders.
I. Differentiation of early schizophrenia and early depression
Early schizophrenia often presents with depression-like symptoms of bad mood that can be misdiagnosed as depression. In recent years, we have seen 60% of early schizophrenia misdiagnosed as depression, and some misdiagnosed and mistreated for several years, which is distressing.
The key points of clinical differentiation are.
1. Although schizophrenic patients complain of bad moods in the early stages, they cannot clearly tell how bad their moods are like depression, especially those negative experiences of sadness and sorrow and lack of interest in life. Therefore, emotions are often “muddled” and “unclear”, and the doctor is often confronted with a cold stone, with no emotional communication. But this often requires extensive clinical experience and the ability to empathize in order to experience the nuances of emotion. So not all people are suited to be psychiatrists, and doctors who are too extroverted have a weaker ability to empathize than those who are introverted and often do not and do not experience these emotions.
2, schizophrenia patients with early bad mood is mainly secondary to hallucinations or delusions, the prodromal phase is likely to be secondary to brain chaos, has been unable to face the previously familiar world as before and discomfort, and thus bad mood. Therefore, when facing schizophrenia patients with early bad moods doctors should carefully ask the reasons for the bad moods.
3, schizophrenia patients with early bad mood due to the lack of self-awareness, often bad initiative to seek medical help, depression early will take the initiative to seek medical help. Of course, some early schizophrenia patients with somatic delusions will go beyond the ordinary to seek medical attention, but seek treatment for delusions of somatic discomfort, not bad mood.
4. Early schizophrenia patients have impaired social functioning and refuse to go to school and work and are indifferent, but early depression patients will try to go to school and work by any means possible and will regret being upset even if they cannot go to school and work.
5. Patients with early schizophrenia sometimes have symptoms that are not present in early depression, such as abnormal self-experience, some unformed hallucinatory symptoms and delusional symptoms, some mildly absurd and bizarre ideas, dullness, self-talk, and self-laughing.
Second, the distinction between early depression and early schizophrenia
Some depression will have some hallucination-like symptoms and delusional symptoms will be misdiagnosed as schizophrenia, the main points of clinical differentiation are.
1. Although hallucinations and delusional symptoms may occur in the early stages of depression, these symptoms mostly follow a decline in work capacity. The above-mentioned patients maintain good social functions before the onset of the disease, such as being the backbone of a unit, or even being in charge, or being an outstanding student in school, and at some time have the feeling that they are unable to complete their work or study tasks, and that the quality of completing their work tasks and studies is not high. At this time, they will feel that their leaders, colleagues, and classmates will look at them in a different way, or talk about them behind their backs. That is, such hallucinations and delusions often occur secondary to psychological stress, secondary to depression, and secondary to self-condemnation and self-blame. In contrast, hallucinations and delusions in schizophrenia are often unexplained and incomprehensible.
2. The core symptoms of depression are obvious in this group of patients, as well as markedly low mood, markedly reduced interest, markedly reduced energy and physical strength, and other common symptoms of depression are more or less common. In contrast, early schizophrenia, even though the mood is bad, but does not have the core symptoms of depression with a significant decrease in energy and physical strength.
3, early depressive experience of depression is distinct, such as the ability to clearly tell how bad the mood, especially those sad and sorrowful, lifeless negative experience, and emotional communication with the doctor. However, the emotions in early schizophrenia are often “muddy” and “unclear”, and the doctor will often be like facing a cold stone, with no emotional communication.
Some depressions are misdiagnosed as schizophrenia because they do not go to school or work and some doctors consider the characteristic symptom of schizophrenia to be “lack of will”.
1. The main difference is the emotional experience. Although such patients do not go to school and work, the depressive experience is distinct, such as the ability to clearly talk about how bad the mood, especially those sad and sad, no interest in the negative experience, there is emotional communication with the doctor. But early schizophrenia mood is often “muddy” and “unclear”, the doctor will often be like facing a cold stone, no emotional communication.
2. These patients do not go to school or work because they have high expectations of themselves and are afraid that they will not learn or do well, so they do not go to school or work. Unlike schizophrenia, where the patient does not want to go to school or work at all, he or she lives a lazy life at home and has poor self-care.
3. Such patients will not have obvious other positive symptoms of schizophrenia even at home for many years.
Some depressions are misdiagnosed as schizophrenia because they are not rich in expression due to their innate introversion, which is considered by some doctors to be a characteristic symptom of schizophrenia, “emotional blandness”.
1. The main difference is the emotional experience. Although these patients are not rich in expression, the depressive experience is distinct, such as the ability to clearly tell how bad the emotions, especially those sad and sad, no life negative experience, and the doctor has emotional communication. But early schizophrenia emotions are often “muddy” and “unclear”, doctors often face a cold stone, there is no emotional communication.
2. Such patients will actively seek medical help, but schizophrenic patients refuse to seek medical help.
3, such patients will also not have obvious other positive symptoms of schizophrenia.
Sometimes early schizophrenia and early depression are difficult to distinguish even for the most experienced physicians. There are two schools of thought on how to deal with this situation.
(1) treat the schizophrenia first, because schizophrenia will miss its optimal treatment period if not treated urgently, and depression will heal spontaneously in early stages and will not be delayed without treatment.
(2) Treat depression first, if it is schizophrenia, the symptoms will be triggered, and then it will be diagnosed well, if it is depression, everything will be fine. Personally, I prefer the first school of thought. The family also needs to give the doctor time to make a clear diagnosis. Often, the family does not give the first doctor time to make a clear diagnosis, and the first doctor makes a correct diagnosis based on the experience of the second doctor, and the family becomes resentful of the first doctor. It is important to understand that doctors are human beings and not gods.
Third, the distinction between early schizophrenia and early anxiety disorder
Early schizophrenia often presents with anxiety-like symptoms of irritability or somatic anxiety symptoms of excessive concern for the body, while the positive symptoms are not very obvious at this time, and thus are often misdiagnosed as anxiety disorders. In recent years, a large proportion of early schizophrenia patients have been misdiagnosed as anxiety disorders, and some have been misdiagnosed and mistreated for several years, while family members often prefer to believe that it is anxiety disorders rather than schizophrenia, which is distressing.
The main points of clinical differentiation are.
1. Although schizophrenia patients show early symptoms of anxiety-like symptoms of irritability, they cannot clearly describe the emotional experience of anxiety as in anxiety disorders, so their emotions are often “muddy” and “unclear”, and the doctor is often faced with a dull and lifeless The doctor is often confronted with a dull and lifeless stone, without emotional communication. But this often requires extensive clinical experience and the ability to empathize in order to experience the nuances of emotion. So not all people are suited to be psychiatrists, and doctors who are too extroverted are less empathic than introverted doctors and often do not and do not experience these emotions. Early irritability in patients with schizophrenia often also fails to describe the vegetative nervous system symptoms characteristic of typical anxiety, such as panic, hand tremors, and sweating.
2. Some adolescent anxiety disorder patients exhibit early symptoms of somatic anxiety with excessive concern for the body, but not to the extent that early schizophrenia patients are concerned about the absurd, such as to the extent that their organs are deformed, to the extent that many people around them are concerned about them because of this, or to the extent that the organ of concern is “eliminated”. Patients with somatic anxiety describe somatic discomfort in a way that is still in the realm of understandable illness.
3. Early irritability in schizophrenia patients is mainly secondary to hallucinations or delusions, and the prodromal phase is likely to be secondary to brain disorder, which is no longer able to face the previously familiar world as before and is therefore irritable. Therefore, when facing a schizophrenic patient with early irritability, the doctor should carefully inquire about the cause of the irritability.
4, schizophrenia patients with early irritability are often not good at taking the initiative to seek medical help because they do not have self-awareness, and anxiety disorders early on will take the initiative to seek medical help. Of course, some early schizophrenia patients with symptoms of somatic anxiety accompanied by excessive concern for the body will go beyond the ordinary to seek medical attention, but seek treatment for delusions out of somatic discomfort, rather than emotional irritability.
5. Patients with early schizophrenia have impaired social functioning and refuse to go to school and work and are indifferent, but patients with early anxiety disorders will try to go to school and work, and will regret being upset even if they cannot go to school and work.
6. Patients with early schizophrenia sometimes have symptoms that are not present in early anxiety disorders, such as abnormal self-experience, some unformed hallucinatory symptoms and delusional symptoms, some mildly absurd and bizarre ideas, floundering, and self-talk.
Differentiation of early anxiety disorder and early schizophrenia
Some anxiety disorders may have some hallucination-like symptoms and delusional symptoms that may be misdiagnosed as schizophrenia, and the main points of clinical differentiation are.
1. Although early anxiety disorders may have hallucinatory symptoms, these hallucinations are often primitive hallucinations (nonverbal sounds), unlike schizophrenia, which is verbal and commentary hallucinations. Although delusion-like symptoms can occur early in anxiety disorders, worrying about one’s delusions can often find a psychological component, and many of the delusions are often, again, about people around them getting into bad situations. Unlike schizophrenia delusions come out of nowhere and delusions are directed at themselves.
2. Such patients have obvious core symptoms of anxiety, such as nervousness and restlessness, as well as symptoms of the vegetative nervous system, such as panic, hand tremors, and sweating. In contrast, early schizophrenia does not have vegetative nervous system symptoms even though it is tense and restless.
3. The anxiety experience in early anxiety disorder is distinct, such as the ability to clearly tell how bad the mood is, the experience of nervousness and anxiety, the expression is often a sense of trepidation, and there is emotional communication with the doctor. But early schizophrenia emotions are often “cloudy” and “unclear”, doctors are often like face to face with a dull and lifeless stone, no emotional communication, no emotional communication.
Some early anxiety disorders are misdiagnosed as schizophrenia because they do not go to school or work, or even live a lazy life at home with poor self-care, which is considered by some doctors to be a characteristic symptom of schizophrenia “lack of will”.
1. The main difference is the emotional experience. Although these patients do not go to school and work, the anxiety experience is distinct, such as the ability to clearly tell how bad the emotions, especially those of nervousness and anxiety experience, and emotional communication with the doctor. However, the emotions of early schizophrenia are often “muddy” and “unclear”, and doctors are often faced with a dull, lifeless rock with no emotional communication.
2. These patients do not go to school or work because they have high expectations of themselves and are afraid that they will not learn or do well, so they do not go to school or work. Unlike schizophrenia where the patient does not want to go to school or work at all, the patient is lazy at home and has poor self-care.
3. Such patients will not have obvious other positive symptoms of schizophrenia for many years at home.
V. Differentiation of early schizophrenia and early OCD
Early schizophrenia often has repetitive ideas or thought content, repetitive actions, and other positive symptoms are not very obvious at this time, and patients often have a certain sense of distress and seek treatment, and thus are often misdiagnosed as OCD. In recent years, we have seen a large proportion of early stage schizophrenia patients misdiagnosed as OCD in clinical practice, and some have been misdiagnosed and mistreated for several years, while family members often prefer to believe that it is OCD rather than think about schizophrenia, which is a sad mistake.
The main points of clinical differentiation are.
1, schizophrenia patients in the early stage, although the performance of repeated ideas or thinking content, repeated actions, but repeated ideas or thinking content is often absurdly bizarre, haphazard, repeated ideas or thinking content is often involuntarily appear, can not be like OCD, repeated ideas or thinking content is still within the scope of understandable, the form of thinking is more regular, often due to their own worry and their own The form of thinking is more regular, often due to their own fears and their own initiation.
2. Emotional communication is an important indicator to distinguish early schizophrenia from OCD. Early schizophrenia patients are often “muddy” and “unclear” emotions, and doctors are often faced with a dull, lifeless stone, without emotional communication, and doctors do not feel the patient’s pain. But OCD patients are better at communicating their emotions, and doctors can feel the pain of the patient’s anti-compulsion.
3. Although it is said that schizophrenia has no self-awareness and OCD has self-awareness, this distinction is made for schizophrenia in the obvious disease stage, and for OCD not yet in severe chronicity. Early schizophrenia patients, especially in the prodromal phase, have a sense of illness, and at this time it is not possible to distinguish between the two diseases by the presence or absence of self-awareness.
4. Although it is said that there is some impairment of social functioning in the early stages of schizophrenia and OCD social functioning remains relatively intact, this distinction is made between schizophrenia with severe symptoms and OCD before it reaches severe chronicity. Some schizophrenia patients early, especially in the prodromal phase social function remains relatively intact, OCD to severe chronic social function will have some impairment, at this time and can not rely on self-awareness to distinguish between the two diseases.
Six, early OCD and early schizophrenia to distinguish
Some early OCD thinking content appears somewhat absurd and bizarre, such as repeated thoughts of sexual relations with their mothers or sisters and suffering, some early OCD repeatedly looking for things that do not exist underground, such as bugs, black dots, etc., appear somewhat incomprehensible, will be considered as a class of delusional symptoms will be misdiagnosed as schizophrenia, the main points of clinical differentiation are.
1. Although the content of thinking in the early stages of OCD appears somewhat absurd and bizarre, it is generally only one or two types of thinking content that recurs, and the form of thinking is more regular, often due to self-initiated, counter-compulsive performance. Unlike schizophrenic delusions that come out of nowhere, delusions tend to generalize, i.e., the content of recurrent thoughts involves more and more surrounding objects.
2. Emotional communication is an important fingerprint for distinguishing OCD from early schizophrenia. Patients with OCD have better emotional communicability, and doctors can feel the pain of the patient’s counter-compulsions. But schizophrenia patients early emotions are often “muddy” and “unclear”, the doctor will often be like facing a dull and lifeless stone, no emotional communication, the doctor can not feel the patient’s pain.
3, therapeutic diagnosis is also a way out. OCD will be effective with anti-compulsive medication, while schizophrenia is ineffective with anti-compulsive medication in the early stages.
Some OCD to severe chronic when social function will be significantly impaired, can not go to work, personal hygiene can not be taken care of, to no counter-compulsive performance, at this time will be considered a lack of will and diagnosed as schizophrenia. The main points of clinical differentiation are.
1, OCD social function will be significantly impaired, can not go to work, personal hygiene can not be taken care of is often more serious compulsive actions, lasting a long time resulting in the inability to go out, can not take care of their own hygiene, if some patients’ compulsive actions will last for several hours, some patients will be wrapped up stool on the side of the bed. However, schizophrenia’s not going to work and personal hygiene cannot be taken care of for no reason, it is that they simply do not want to do it.
2. Even though social functioning is significantly impaired in OCD, there are no other psychotic symptoms, and there is still some communicability of emotions. However, when schizophrenia patients have significantly impaired social function, they tend to be more ill or in decline, and will definitely have other psychotic symptoms, such as hallucinations, delusions, self-talk and self-laughter, etc. Emotions must be indifferent and there will be no communicability.
3, therapeutic diagnosis is also a no way out. OCD will be combined with antipsychotics when it is severe, but but antipsychotics alone will definitely be ineffective, and a certain combination of anticompulsive drugs can have some effect.
Seven, early schizophrenia and mania differentiation
Some youthful schizophrenia early stage will have exaggerated ideas, active but slightly incongruent emotions will be misdiagnosed as bipolar disorder.
The key points of clinical differentiation are.
1, the exaggerated ideas in the early stage of youth-type schizophrenia are often absurd and bizarre, making it difficult to understand, and there is no infectious place, but the exaggerated ideas in mania are somewhat understandable, and there is an infectious place.
2. The behavior of youthful schizophrenia disorder seems silly and incomprehensible, and there is no infectious place, but the behavior of manic disorder has a certain comprehensibility and an infectious place.
Eight, mania and schizophrenia early differentiation
Some early stages of mania will have some hallucination-like symptoms, delusion-like symptoms, some seemingly absurd and bizarre ideas, and incongruous emotions and behaviors will be misdiagnosed as schizophrenia. The main points of clinical differentiation are.
1, some early mania will have some hallucinatory symptoms, delusional symptoms, some seemingly absurd and bizarre ideas, uncoordinated emotions and behaviors, but the duration is short, hallucinatory symptoms often have a certain psychological cause, the content is often to boast of their own, delusional content or “dreaming of marrying a wife”, the victim is often the first to feel great Others are jealous of them and want to harm them. However, the hallucinations and delusions of schizophrenia last for a longer period of time and are often unexplainable and incomprehensible because the cause cannot be found.
2. Even in the case of mania, which is clinically relatively chaotic, it still retains a certain comprehensibility and has an infectious place, but schizophrenia seems silly and incomprehensible when it is disordered, and has no infectious place.
Finally, early misdiagnosis of mania and schizophrenia will not significantly affect treatment in most cases. Because antipsychotics are applied in the treatment of both, the application of emotion stabilizers plus antipsychotics will not affect the efficacy of schizophrenia treatment, so families can rest assured. However, in a few cases of mania, only antipsychotics are used without emotion stabilizers, and the manic symptoms remain uncontrolled or the emotion is not well controlled, and the mania becomes chronic and social functioning is impaired.